Healthcare Provider Details

I. General information

NPI: 1487628491
Provider Name (Legal Business Name): JEWELL PATRICIA HICKMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11138 OLD SAINT CHARLES RD
SAINT ANN MO
63074-2113
US

IV. Provider business mailing address

9800 EDGEFIELD DR
SAINT LOUIS MO
63136-5419
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-0983
  • Fax: 314-344-0983
Mailing address:
  • Phone: 314-503-2696
  • Fax: 314-344-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2002010842
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2002010842
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: